Clin Endosc.  2017 Jan;50(1):69-75. 10.5946/ce.2016.079.

Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center

• Hermans C
• Stronkhorst A
• Tjhie-Wensing A
• Kamphuis J
• van Balkom B
• Dahlmans R
• Gilissen L

• KMID: 2383493
• DOI: http://doi.org/10.5946/ce.2016.079

Abstract

BACKGROUND/AIMS
Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications.
METHODS
Retrospective observational study.
RESULTS
DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE.
CONCLUSIONS
In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant.

Keyword

Double-balloon endoscopy; Capsule endoscopy; Anemia; Hemorrhage; Intestine, small

MeSH Terms

Anemia
Angiodysplasia
Capsule Endoscopy
Endoscopy*
Hemorrhage*
Humans
Intestine, Small
Observational Study
Pancreatitis
Pathology
Retrospective Studies
Tertiary Care Centers*

Figure

• 

  Fig. 1. Flowchart of procedures performed in our study. A total of 205 double- balloon endoscopy (DBE) procedures are performed for the indication of overt or occult bleeding, of which 134 were preceded by videocapsule endoscopy (VCE), and 71 were not preceded by VCE.

• 

  Fig. 2. Findings in antegrade (n=149) and retrograde (n=56) double-balloon enteroscopy for indication of overt or occult bleeding (n=146) based on location. In anterograde double-balloon endoscopy (DBE) procedures, 76% of positive findings were located in the jejunum, mostly angiodysplasias (63%). Retrograde DBEs only visualized the ileum of the small bowel and showed different findings.

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